The results of simultaneous posterior–anterior–posterior surgery in multilevel tuberculosis spondylitis associated with severe kyphosis

Abstract

We retrospectively studied the cases with tuberculous spondylitis of thoracolumbar region with two or more levels of involvement that underwent posterior instrumentation and fusion and anterior fusion with titanium mesh following anterior decompression using simultaneous successive posterior-anterior-posterior surgery. Among all patients with tuberculous spondylitis accompanied by medium or severe kyphosis, 20 patients who underwent simultaneous successive decompression, fusion and instrumentation with posterior-anterior-posterior surgery between 1999 and 2004 were included in the study. Patients were evaluated for fusion formation and neurological and functional status. Kyphosis angles were measured at early and long-term follow-up. Antituberculosis chemotherapy was initiated in all patients and continued for 9 months; initially as quadruple therapy for 3 months, and then as triple therapy. Average follow-up period was 52.7 months (range 37-94). Solid fusion was achieved in all patients. All patients returned to their previous occupation; 75% (15 subjects) with mild pain or no pain and 15% (3 subjects) with major limitations. There were 11 patients with neurological deficit, 9 of these achieved complete neurological recoveries. Regarding kyphosis angle, an average 35.1°correction (84.8%) was obtained in postoperative period (p \ 0.001) and there was no significant correction loss during the follow-up period (p \ 0.05). There were no grafts or instrumentation-related stabilization problems. In subjects with tuberculous spondylitis with involvements at two or more levels accompanied by medium and severe kyphosis, decompression, fusion and instrumentation by simultaneous successive posterior-anterior-posterior surgery is an effective and safe management method for effective kyphosis correction with high fusion rates.

Posterior mono-segmental fixation, combined with anterior debridement and strut graft, for treatment of the mono-segmental lumbar spine tuberculosis

“…However, instability of graft in the "Hong Kong operation" leads to graft movement, absorption and breakage; these complications pose problems for the use of graft fusion and have been shown to cause a high incidence of kyphosis deformity [1][2][3]. To solve this problem, anterior or posterior internal fixation is commonly selected in combination with "Hong Kong operation" to prevent and correct the deformity, stabilize the spinal cord, promote graft fusion and facilitate quick patient recovery [4][5][6][7][8][9]. Nowadays, debridement, deformity correction, graft fusion, as well as internal fixation are routine methods for the treatment of spinal tuberculosis [10][11][12][13].…”

A retrospective controlled study of three different operative approaches for the treatment of thoracic and lumbar spinal tuberculosis: Three years of follow-up

“…Generally, the prevalent methods of surgical treatments are divided into two http://dx.doi.org/10.1016/j.clineuro.2014. 10.019 0303-8467/© 2014 Elsevier B.V. All rights reserved. types: one-stage anterior approaches (AA) for debridement and spinal fusion [5,6], and one-stage posterior approaches (PA) for debridement and spinal fusion [7,8].…”

“…types: one-stage anterior approaches (AA) for debridement and spinal fusion [5,6], and one-stage posterior approaches (PA) for debridement and spinal fusion [7,8]. Some scholars have mentioned a third type of treatment; i.e., a combined anterior and posterior approach (CAPA) [9,10]. In this method, the vertebral body is fused in front of the spine, and a fixation is installed in the rear of the spine.…”

Tuberculosis of ultralong segmental thoracic and lumbar vertebrae treated by posterior fixation and cleaning of the infection center through a cross-window

“…Ultralong segmental spinal TB may result from the onset of disease because of the doctors' incomplete understanding or delayed surgical treatment during the patient's first visit [3][4][5]. The wide scope of the lesions and the number of vertebrae involved make it difficult to cure these patients.…”